Prospective multicenter feasibility study of omnipolar near-field peak-frequency mapping for slow-pathway localization in typical atrioventricular nodal re-entrant tachycardia.
Giaccardi M, Cartei S, et al. • BMC cardiovascular disorders • 2026
In this prospective multicenter cohort, OTNF-derived PF mapping was feasible and reproducibly identified a discrete region used to guide SP ablation in typical AVNRT, though ROC-derived thresholds and performance estimates are exploratory and require independent validation.
Key Findings
Results
Acute procedural success was achieved in all 50 patients with typical AVNRT, with no procedural complications, using peak-frequency (PF)-guided slow-pathway ablation.
Fifty consecutive adults with inducible typical AVNRT were treated at three Italian hospitals.
High-density right atrial mapping was done in sinus rhythm with a 16-pole grid catheter (Advisor HD Grid) and omnipolar near-field (OTNF) technology on the EnSite X system.
RF applications were delivered to the region of highest PF (high-frequency threshold >250 Hz).
Results
The effective ablation site corresponded to the highest PF region in 90% of patients.
Concordance was observed in 45/50 patients (90%).
The effective site was defined as junctional beats with subsequent SP modification and/or non-inducibility.
Results
In a retrospective analysis, the effective ablation site fell within the low-voltage bridge (LVB) region in 72% of patients, and PF-defined and LVB-defined regions were concordant at the effective site in 70%.
Effective site within LVB region in 36/50 patients (72%).
PF–LVB concordance at the effective site in 35/50 patients (70%).
Voltage maps delineated LVB regions (typically 0.04–2 mV); LVB was not used to select ablation targets.
Results
Mean peak frequency was significantly higher in the slow-pathway target region than in surrounding tissue.
Mean PF was 424 ± 86 Hz in the SP target region versus 272 ± 57 Hz in surrounding tissue.
P < 0.05 on paired testing.
Results
Exploratory ROC analysis showed high discrimination of the SP target region by PF, with an optimal cutoff of 357 Hz.
AUC was 0.937.
Sensitivity 0.87 and specificity 0.94 at the 357 Hz cutoff.
The authors caution that estimates may be affected by incorporation/target-selection bias because PF guided RF target selection.
Conclusions
The authors conclude that OTNF-derived PF mapping is feasible and reproducibly identifies a discrete region used to guide SP ablation, but thresholds need independent validation.
Study was a prospective multicenter cohort of 50 patients.
ROC-derived thresholds and performance estimates are exploratory.
Validation is needed in cohorts where ablation targets are not selected using PF criteria.
What This Means
This study tested a new mapping technique to help doctors find the right spot to treat a common type of fast heart rhythm problem called typical AVNRT. The usual treatment is to burn (ablate) a small area of tissue called the slow pathway, but finding it can sometimes be difficult. Here, doctors in three Italian hospitals used a high-density mapping catheter and software that measures the frequency content of the heart's electrical signals, and they aimed treatment at the area with the highest peak frequency.
In all 50 patients the procedure was acutely successful, with no complications. The spot where ablation worked matched the highest-frequency area in 90% of patients. Signal frequency was clearly higher at the target (about 424 Hz) than in nearby tissue (about 272 Hz). A secondary look at low-voltage areas found that the successful site lay within one in 72% of patients.
This research suggests the approach is feasible and may be a useful additional guide for locating the slow pathway. However, because the frequency maps were used to choose where to ablate, the accuracy figures (such as the 357 Hz cutoff) may look better than they really are. The study was small and had no comparison group, so larger studies in which the frequency map does not determine the ablation site are needed to confirm these results.
Giaccardi M, Cartei S, Mangiafico V, Narducci M, Scacciavillani R, Zampieri M, et al.. (2026). Prospective multicenter feasibility study of omnipolar near-field peak-frequency mapping for slow-pathway localization in typical atrioventricular nodal re-entrant tachycardia.. BMC cardiovascular disorders. https://doi.org/10.1186/s12872-026-06779-5